A bone fracture is a traumatic disruption of the continuity of a bone. If there is relative motion of the bone fragments at the fracture site irritation of the surrounding tissues and heavy pain ensue and the time of fracture healing is usually extended. Proper rejoinder of bone fragments is thus dependent upon the immobilization of the fracture site. Classically, bone fragment reduction (bone fragments properly aligned and abutted along the fracture line) and immobilization for fractured limb bones has been accomplished by external limb casts. Such casts must be worn for long periods of time, are heavy and unbalancing to the body skeletal structure and muscular system, inhibit bone vascularity (promotes fast and effective bone healing), and may result in bone resorption because of the total absence of tensile and compressive functional force loading throughout the fractured bone structure. Fractures in bones other than the arms and legs are more difficult to immobilize and the use of exterior casts may not be possible.
Over the past twenty-five years the use of compression plate techniques for internal fixation of fractures have been developed and widely applied. With internal fixation, by means of bone screws and compression plates, particularly plates made of biocompatible metals and metal alloys (such as titanium and stainless steel), immediate and absolute immobilization is achieved through interfragmentary compression. Other materials and devices such as wires, intramedullary nails or externally fixed pins are used mainly to reduce bone fracture mobility and improve the position of the fracture segments. The basic aim of internal bone fracture fixation is to allow early, pain-free movement of the injured limb, mandible, etc., thus avoiding the consequences of long lasting immobilization, i.e., bone fracture disease, bone resorption, etc.
In addition to the use of bone screws and compression plates to effectively accomplish internal bone fracture fixation, implantable biocompatible metallic plates are being increasingly used in oral and maxillofacial surgery to effect the surgical correction of craniofacial anomalies. Craniofacial surgery requires the use of both compression and non-compression plates. Thus, in orthognathic procedures, is may not be desirable to compress an osteotomy. Also, midfacial trauma injuries are frequently treated through the use of non-compression bone fixation plates.
With internal bone fixation it is important that the application of the implanted plate or fracture reduction device result in relative immobility of the bone fragments (fracture situations) or surgically prepared bone parts (reconstruction situations) and tight closure of the bone interfaces. Without such immobility and tight closure, changing tension and compression loads tend to produce relative motion at the bone interfaces with resultant undesirable bone fragment or bone part shortening due to bone resorption. Through the proper use of a biocompatible metallic bone stabilization plate or fracture reduction device (a surgically applied implant), static forces applied by the plate or device prevent relative motion between the bone interface surfaces. Thus, complete immobilization and stabilization of the bone fragments or bone parts (through the plate or device) prevents relative motion at the bone interfaces in spite of functional use of the limb, mandible, etc., without external immobilization or splinting. With mechanical stimuli (forces and motion) permitted via internal bone fixation techniques, rapid and healthy healing of a fracture or surgical reconstruction is promoted and bone vascularity is maintained and restored. Vascularity of bone is interrupted by the fracture trauma and by surgical intervention but revascularization is restored and enhanced by the rigid immobilization of the bone fragment or bone part interfaces through internal fixation techniques.
Further developments in compression and non-compression bone fixation plate designs and attachment screws (also formed of biocompatible metals and metal alloys) have related to screw head and screw hole geometry, i.e., conical geometry of the screw shoulder and oval screw holes in the fixation plate for promoting bone fragment compression during screw application. Attempts to obtain optimal stability of fixation have most recently resulted in the use of congruent fitment between the underside of the head of bone screws and the screw holes in the fixation plate including both counter-sunk holes (conical geometry) and hemicylinderical holes. Also, the development of low head profiles for bone screws has permitted the use of implantable bone plates in fixation situations directly below soft tissue body surfaces without causing cosmetic appearance abnormalities or creating an uneven and irritating surface characteristic of such plates otherwise caused by screw heads.
Over the past ten years there has been an increasing interest in, and use of, perforated biocompatible metallic strips and panels as a means for rigid internal fixation of fractures in trauma surgery and as a plate material for bone part immobilization and stabilization and bone graft support material in orthognathic and reconstructive surgery. Of particular interest has been the use of perforated strips and panels fabricated of titanium as an unequaled implant material in use clinically for over 30 years with no documented cases of allergic reactions. Pure titanium is the material of choice in craniofacial reconstructive surgery when non-removal of the implant is indicated. As an implant material, pure titanium is preferred because its low density (weight) and elastic modulus (stiffness) are approximately one-half that of stainless steel or cobalt-chromium alloys and the material is corrosion resistant and pliable. Bone plates made from perforated titanium strips and perforated titanium panels can be cut to appropriate configuration and contoured at the time of surgery and, when affixed to bone fragments or bone parts with bone screws, provide solid, stable fixation means during trauma surgery and planned reconstructive surgery.
A preferred form of perforated titanium strips and panels (titanium mesh) includes rows of substantially square perforations which are formed in titanium sheet material by mechanical means (stamping and machining), by electrical arc cutting, and by milling means which preserve the stress free condition of the sheet material. The use of titanium mesh with square holes for internal fixation of bone fractures and for reconstructive surgery provides the surgeon with an implantable plate material which can be easily cut to desired contour and shaped or bent to conform to bone fracture and reconstruction sites without inducing mechanical stresses into the material because the formability of such mesh is equal along each of the legs defining each of the square holes. Also, as a perforated sheet material the plate structure provides the surgeon with a multiplicity of ready-made holes through which bone screws can be seated and applied to fasten the plate structure to bone fragments and parts. Bending of the perforated sheet material does not distort the square holes to the extent that bone screws can not be applied. This is not the case with mesh implant structures wherein the perforations are round holes. While perforated titanium implant strips and panels of the type described (square holes) provide the trauma and reconstructive surgeon with a highly desirable bone fixation plate structure, such panels and strips have in the past required that the screws applied through the plate structure have their head portions extend above the outer plate surface. Although in many internal bone fixation and reconstructive situations screw head protrusion is not an objectionable factor and causes no problem with respect to the healing process following surgery, where the implanted plate structure is at or near the body surface the protrusion of screw heads may be noticeable and irritating.
It is a principal object of the present invention to provide a unique perforated metallic plate structure for the internal fixation of fractures and for use in orthognathic and reconstructive surgery.
It is a further object of the invention to provide a unique metallic plate structure, including a multiplicity of chamfered square perforations for receiving bone screws, for use in orthognathic and reconstructive surgery and for rigid internal fixation of bone fractures in trauma surgery.
It is still a further object of the invention to provide unique perforated metallic panels and strips for use in orthognathic and reconstructive surgery and for rigid internal fixation of bone fractures with the panel and strip perforations comprising a multiplicity of substantially square chamfered holes arranged in rows and lines.
It is yet another object of the present invention to provide a unique perforated metallic plate structure, including arcuately chamfered square screw holes, for use in orthognathic and reconstructive surgery and for rigid internal fixation of bone fractures without the significant protrusion of the head portion of bone screws applied through such screw holes into the bone fragments or parts to which the plate structure is attached.
It is still another object of the invention to provide unique perforated metallic panels and strips for use in orthognathic and reconstructive surgery and for rigid internal fixation of bone fractures with the panel and strip perforations comprising a multiplicity of substantially square holes which are arcuately chamfered for receiving the hemispherical underside of low profile bone screws.
Other objects and advantages of the invention will be apparent from the following summary and detailed description of the bone fracture and bone reconstruction fixation plate structure of the invention taken together with the accompanying drawing figures.